Possible interactions between zolpidem,a new sleep inducer and chlorpromazine,a phenothiazine neuroleptic

The combined use of a hypnotic and a neuroleptic is a rather frequent situation, encountered especially in the psychiatric sphere. We therefore tested zolpidem and chlorpromazine in six healthy subjects by using a double-blind latin square design. All of them received single doses of 20 mg zolpidem (ZOL), 50 mg chlorpromazine (CPZ) and the combination of ZOL+CPZ. The medication was given as a single dose in the morning and each treatment being separated by a 1-week interval. Zolpidem produced moderate to severe sedation varying according to the subjects. Psychometric performances (manual dexterity, Stroop test), alertness and psychomotricity (visual analogue scales) were reduced up to 3 h after drug intake. Chlorpromazine alone did not have much effect. Combined administration of ZOL and CPZ was rather more effective than ZOL alone. The pharmacokinetics of ZOL or CPZ remained unchanged except for the elimination half-life of CPZ, which increased significantly when administered along with ZOL. No other pharmacodynamic or pharmacokinetic interaction between ZOL and CPZ was evident. The fact that the ZOL and CPZ combination accentuated the pharmacodynamical effects can be explained to result from the summation of each of their own pharmacological effect.     

Sleep apnea and nocturnal myoclonus in the elderly

—Insomnia, daytime sleepiness, and nocturnal wandering, so common in the elderly, are caused largely by two specific pathophysiologic processes. Sleep apnea is a condition where respiration pauses during sleep, leading to arousal. Sleep apnea is due either to obstruction in the throat or failure of the central respiratory center. Periodic movements in sleep are characterized by frequent ankle and leg flexions, leading to arousal. Sleep apnea and periodic movements in sleep require specific diagnoses and treatments. Each process occurs in 20%–30% of people over 65, and perhaps the majority of older people have one or the other condition or both. Because of possible interactions with these sleep disorders, the widespread prescribing of sleeping pills to elderly patients is irrational and often dangerous. In the future, large-scale clinical trials will be needed to define effective long-term treatments for these conditions and to define when treatment is worthwhile.     

Sleep-related vagotonic effect of zolpidem in rats

Rationale Zolpidem is a relatively new nonbenzodiazepine sedative–hypnotic. The effects of zolpidem on autonomic functions remain unclear. Objectives The aim of this study was to evaluate the effects of zolpidem on sleep and related cardiac autonomic modulations as compared with triazolam in Wistar–Kyoto rats. Methods Continuous power spectral analyses of electroencephalogram (EEG), electromyogram, and heart rate variability were performed on freely moving rats during daytime sleep. The consciousness states were classified into active waking (AW), quiet sleep (QS), and paradoxical sleep (PS). Drugs were administered via gavage and data within 2 h were analyzed. Results All zolpidem (ZP3, 3 mg/kg; ZP30, 30 mg/kg) and triazolam (TZ0.075, 0.075 mg/kg; TZ0.75, 0.75 mg/kg) groups had longer accumulated QS time and averaged QS duration as compared with the vehicle control. The accumulated QS time and averaged QS duration of ZP3 were similar to those of TZ0.075. Significant suppressions of PS time were noted in all drug groups except ZP3. During QS, ZP3 and ZP30 exhibited significant increases of magnitude and percentage of EEG δ power, whereas TZ0.075 and TZ0.75 did not. Heart period and high-frequency power of heart rate variability increased significantly in ZP3 during all sleep–wake states. Both parameters, however, did not increase but even decreased in ZP30, TZ0.075, and TZ0.75. Conclusions Zolpidem not only caused a longer and deeper sleep but also led to an elevated cardiac vagal activity at a specific dose in the rat.     

国产缬草属4种药用植物镇静催眠作用的比较研究

目的研究比较国产缬草属4种药用植物的镇静催眠活性。方法通过观察其乙醇提取物对小鼠自主活动及戊巴比妥钠诱导小鼠睡眠时间的影响来评价其镇静催眠活性。结果中国缬草、宽叶缬草、蜘蛛香、黑水缬草均具有镇静催眠活性,以宽叶缬草和蜘蛛香活性较强。结论宽叶缬草及蜘蛛香药用植物等在镇静催眠方面具有开发利用潜力。     

Discriminating between epileptic and nonepileptic events: the utility of hypnotic seizure induction

PURPOSE: To determine the validity of the Hypnotic Induction Profile (HIP) followed by seizure induction during continuous video-electroencephalographic (EEG) monitoring to discriminate between epileptic (EE) and nonepileptic events (NEE). METHODS: Eighty-two patients admitted to the Stanford Comprehensive Epilepsy Center for differential diagnosis of seizure-like events were evaluated. Exclusion criteria included inability or refusal to complete the HIP, lack of a "typical" event, an IQ <70, present evidence of psychosis, or a physiological cause for NEE. Sixty-nine patients met these criteria. While undergoing continuous video-EEG monitoring, the patient completed an HIP, an inventory designed to measure the degree of hypnotizability. An attempt was then made to induce the patient's typical events under hypnosis by using a split-screen technique. An event without an EEG correlate was thought to represent an NEE. A diagnosis of NEE was made independently by the neurology team and was compared with results obtained with the hypnotic evaluation. RESULTS: Results for patients with EE were compared with those with NEE and a group consisting of both EE/NEE. All patients with NEE were then contrasted with the EE group. HIP scores for the EE patients indicated lower hypnotizability than the NEE group and were statistically significant when NEE patients and those with NEE/EE were combined. The sensitivity of seizure induction in the diagnosis of NEE was 77%, with a specificity of 95%. CONCLUSIONS: The HIP coupled with seizure induction is a useful technique to aid in the diagnosis of patients with NEE. It is sensitive and specific, and it may provide the patient with a useful behavioral tool to control NEEs. It may also furnish a conduit for long-term treatment.     

失眠的药物治疗策略与评价

目的：睡眠是人体重要的生理活动,人类生存时间的1/3要在睡眠中度过,为此,失眠的药物治疗策略显得尤为重要,本文归纳其治疗用药与评价。方法：综述近期的国内外文献报道。结果及结论：失眠的药物治疗已完成数次过渡,寻求作用于新靶位、选择性强、作用专一的新型催眠药已成为临床关注的课题。伴随着科研的发展,对失眠的根治有望于更多安全有效的催眠药物问世。     

硫喷妥钠的催眠作用与受体的关系

目的观察硫喷妥钠的催眠作用与甘氨酸和阿片受体的关系。方法腹腔注射硫喷妥钠建立催眠作用的小鼠模型,在催眠实验中,观察士的宁、纳洛酮对硫喷妥钠小鼠翻正反射消失持续时间的影响。结果士的宁、纳洛酮对硫喷妥钠小鼠的睡眠时间均有明显影响(P<0.01)。结论甘氨酸受体和阿片受体均介导了硫喷妥钠的催眠作用。     

酸枣仁合剂的镇静安神作用研究

目的探讨酸枣仁合剂对小鼠的镇静、催眠及抑制自主活动的作用。方法采用光电计数仪测定小鼠的活动次数,翻正反射法测定小鼠睡眠时间,观察酸枣仁合剂对正常小鼠的镇静催眠作用。结果酸枣仁合剂高、中、低剂量组均能增加入睡小鼠的动物数,明显抑制其自主活动和生理代谢(活动次数、站立次数及排便粒数),明显延长镇静催眠药物(地西泮)对小鼠的睡眠时间。结论酸枣仁合剂对小鼠有明显的催眠效果,对其自主活动和生理代谢具有明显的抑制作用,与镇静催眠药物地西泮联用具有延长其睡眠时间的作用。     

短半衰期催眠药对失眠症患者白天多次睡眠潜伏期测定的影响

目的 :探讨两种短半衰期催眠药佐匹克隆和三唑仑对失眠患者白天多次睡眠潜伏期测定 (MSLT)的影响。方法 :按照ICD 10的诊断标准收集 2 2例非器质性失眠症患者 ,随机分为两组 ,在服用 0 5mg三唑仑或 15mg佐匹克隆前后 ,分别进行MSLT检测。结果 :两药均可使白天MSLT的平均睡眠潜伏期和前两次测定的睡眠潜伏期明显缩短 ,使REM睡眠增加。两药对MSLT的影响特点相似。结论 :催眠药物可使失眠患者白天的困倦程度明显增高 ,这可能与药物的受体后效应有关 ,与药物种类的关系不大。